An association between suspended rocking cradles and infant death?
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Asphyxia↗
Biomedical subjects
L Moore
Publications and source records attributed to L Moore.
Lessons from Lithuania: rethinking public health training.
Lithuania faces stark problems that are familiar to most countries in the former Soviet Union: high morbidity and mortality rates, pollution, an unstable economy, and rapid changes in the financing and organisation of health care. In this environment Moore and Dixon visited Kaunas Medical Academy to help identify how training in public health medicine could contribute towards improving the health of the population. Although over 200 hours are devoted to public health training for medical undergraduates, teaching is unfocused, fragmented, and includes little epidemiology--the core subject for public health physicians. Teaching is mainly through long lectures with few group discussions. Student participation and motivation are low. As well as recommending redesign of the curriculum, Moore and Dixon suggested training in teaching methods for teachers. They also suggested that postgraduate training in public health should begin and should be targeted at hospital managers, teaching staff, and existing public health physicians.
Curriculum↗
Glomerular dimensions in children under 16 years of age.
Glomerular area, perimeter, and mean maximum glomerular diameter were assessed in post-mortem kidney tissue from 114 children who died suddenly in accidents and who were considered to have been previously healthy. One hundred glomeruli were measured from each case using a computer-based measurement system. Regression analysis was used to analyse glomerular size with respect to age, body weight, height, and body mass index. The estimated mean glomerular area for newborns was 7934 microns 2 (SE 314), increasing 8 per cent per year to 18,219 microns 2 at 15 years of age. The estimated mean maximum glomerular diameter increased from 112 microns (SE 1.9 microns) for newborns, approximately 3.6 microns per year to reach 167 microns at age 15. Glomerular size correlated better with age than with height, weight, or body mass index, and glomeruli in the inner cortex were significantly larger than those in the middle and outer cortex. Glomerular size was significantly greater in female children than in the male children over the age range examined.
Adolescent↗
Epidermolysis bullosa and severe ulcerative colitis in an infant.
An infant with epidermolysis bullosa simplex had diarrhea at 3 weeks of age; severe ulcerative colitis was subsequently diagnosed. Epidermolysis bullosa simplex has not been associated with gastrointestinal disease except for buccal ulceration.
Colitis, Ulcerative↗
Pathological findings in hanging and wedging deaths in infants and young children.
Records of the Adelaide Children's Hospital Histopathology Department were reviewed for cases of deaths resulting from hanging or wedging occurring in early childhood and infancy. The 14 cases identified were analyzed with respect to age, sex, circumstances of death, and postmortem findings. The mean age at death was 14 months (range, 6-36 months) and the male to female ratio was 9:5. In one case, death occurred in a baby car seat, another in a pram/stroller, and in another a curtain cord was responsible. In the remaining 11 cases, death occurred in the baby's crib. In eight cases the mechanism of death was hanging with partial suspension, including six cases in which part of the infant's clothing became caught on the crib. Petechial hemorrhages on the face were found in all of the hanging deaths whereas intrathoracic petechiae were identified in only two cases. Only one of the wedging deaths showed facial petechiae whereas intrathoracic petechiae were identified in four of the six cases. Conjunctival hemorrhages were only recorded in only two of the 14 cases.
Accidents↗
Patient satisfaction: an outcome measure for maternity services.
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Adolescent↗
Pregnancy in women with thyroid disease: a delicate balance.
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Chronic Disease↗
Complete eradication of Aspergillus fumigatus from the lung in an immunocompromised patient by oral itraconazole.
Itraconazole is a new orally active antifungal agent shown to have in vitro and experimental activity against Aspergillus spp. This case report documents the successful eradication of biopsy-proven invasive pulmonary aspergillosis in a 17 year old boy with acute lymphocytic leukaemia. Cerebral involvement by the fungal infection was suspected clinically but was not biopsy proven. Although the patient subsequently died following bone marrow transplant and Escherichia coli septicaemia there was no evidence of residual Aspergillus at autopsy.
Administration, Oral↗
Warning! Schools can damage your health: alienation from school and its impact on health behaviour.
An international study of health behaviour among school-age children was co-ordinated by the World Health Organization (WHO). The data were obtained from a self-completion questionnaire examining key health behaviours and associated psycho-social variables obtained from representative samples of young people in school aged 11.5, 13.5, and 15.5 years. The analysis focuses on the relationship between older (15.5 years) students' attitudes towards school and health behaviours such as regular smoking, alcohol use, physical activity and food choices. The data show a strong and progressive relationship between indicators of 'alienation' from school, and health compromising behaviours among school students from Australia and Wales. This relationship is most obvious with the 'abusive' behaviours of smoking and alcohol misuse. Summary data for nine other countries in the WHO study indicate that this relationship is found consistently across all countries in the study. This substantial minority of students (approximately 30% varying between countries) represents an important target population for efforts to promote healthy lifestyles. Traditional school health education is seen as insufficient to tackle this task and recommendations are made concerning change to the school environment and ethos, and the need to reach young people in their home and community settings.
Adolescent↗
Co-occurrence of substance use and loneliness as a risk factor for adolescent hopelessness.
This research among a sample of 1,915 Mississippi adolescents investigated whether lonely adolescents who use illicit substances were at increased risk of hopelessness. Relative risk of scoring within the severe hopelessness range was 6.9 for non-substance users who were lonely and 4.2 for substance users who were not lonely. Yet, relative risk for severe hopelessness in substance-using lonely adolescents was 25.2. Lonely, substance-using adolescents were 25 times more likely to be severely hopeless than the reference group composed of non-substance using, not-lonely adolescents. Lonely adolescents who get drunk also were 15.9 times more likely to be severely hopeless than the reference group. Because hopelessness often is an indicator of suicidal behavior, these results may have important implications for school health adolescent suicide prevention efforts.
Adolescent↗
Observer reliability in assessing villitis of unknown aetiology.
AIMS: To evaluate observer variation in diagnosis of villitis of unknown aetiology. METHODS: Fifty haematoxylin and eosin stained sections were circulated to three pathologists who were asked to assess if villitis was present. These slides, with an additional 20, were recirculated and reassessed by the same pathologists. RESULTS: Intra-observer agreement was 84.7% (range 74--92%) and interobserver agreement was 81%. A conjoint review by the three pathologists revealed that sources of differences included the overlooking of isolated single or small numbers of affected villi, the difficulty in assessing stromal cellularity close to infarcted parenchyma, and apparent stromal hypercellularity in immature villi. CONCLUSIONS: Experienced pathologists can show a significant interobserver variation in assessing villitis of unknown aetiology. Future studies on villitis of unknown aetiology should address the problem of observer reproducibility of diagnosis.
Chorionic Villi↗
Test and teach. Number seventy-three. Diagnosis: Alexander's disease.
Alexander's disease is a progressive degenerative neurological disorder developing in early childhood which is characterized by accumulation of Rosenthal fibres throughout the cerebral white matter. These fibres are composed of glial fibrillary acidic protein and ubiquinated alpha beta crystallin. The absence of atypia, increased cellularity, mitotic activity or necrosis in biopsy material allows differentiation from neoplasia glial processes. Clinical features suggestive of the diagnosis include progressive mental retardation with an increase in head circumference.
Brain Diseases↗
DNA analysis and clinical outcome in pediatric adrenal cortical tumors.
Adrenal cortical neoplasms are uncommon and it is often difficult to separate benign tumors from those that are malignant. Histology does not provide a reliable guide, particularly in pediatric cases. It has been suggested that analysis of nuclear DNA content may complement conventional histopathologic methods in the diagnosis of malignancy. Six previously reported adrenal cortical tumors from children aged 6 mths to 6 yrs were analysed using a CAS 200 image analysis system which provided DNA histograms on each of the cases. In 5 cases a significant proportion of the tumors showed aneuploidy and in only one case did most of the tumor cells show a diploid pattern. All 6 cases were treated with surgery alone with long term survival and follow up of 2-15 yrs except in one child with a histologically benign aneuploid tumor who died post-operatively from measles pneumonia. No correlation between histological appearance, outcome and ploidy was seen. The aneuploid tumors included those classified by current histological methods as benign (1), indeterminant (2) and malignant (2). The one diploid tumor seen was a large tumor of indeterminant malignancy that did not recur. Although the series is quite small these observations suggest that abnormalities of DNA content may not provide an objective measure of the malignant potential of adrenal cortical tumors in children.
Adrenal Cortex Neoplasms↗
Anesthetic considerations in patients with hyperparathyroidism.
Although there is controversy over which patients should undergo parathyroidectomy, some patients clearly benefit from the procedure. This case illustrates typical findings in a patient with a parathyroid adenoma. Preoperative hydration and electrolyte balance and selection of anesthetic drugs that were easily titrated was associated with a smooth intraoperative course on this patient. Mild hypocalcemia postoperatively was quickly recognized and treated.
Adenoma↗
Sudden and unexpected death in childhood due to a colloid cyst of the third ventricle.
A nine-year-old boy died suddenly and unexpectedly following a two day history of intermittent headaches. At autopsy a colloid cyst of the third ventricle was found that had obstructed the foramen of Monro and caused hydrocephalus with prominent cerebral edema. Colloid cysts are rare entities in childhood and are not usually included in the differential diagnosis of pediatric sudden death. This report describes the clinicopathological features of such a case.
Brain Diseases↗
Continuity of care in the family medicine residency. Results of a national survey of program directors.
Based on the results of a survey of family medicine residency program directors across the country, there is a need for a national consensus on the definition of continuity of care, and on structures for teaching it and methods of evaluating it.
Achievement↗
Late direct angioplasty in patients with myocardial infarction and fluctuating chest pain.
Myocardial infarctions may be associated with reduced but persistent blood flow to the infarct zone. We developed clinical criteria to select patients likely to have persistent perfusion to the infarct zone in the setting of acute myocardial infarction. Twenty-four consecutive patients with fluctuating pain and/or ST segment elevation who presented within 24 hours of the onset of infarction were studied with coronary angiography followed by direct percutaneous transluminal coronary angioplasty. Sixty-seven percent of patients had residual flow to the infarct territory. Eighteen patients had repeat angiography on day 9.4 +/- 4.1, and all arteries were patent (21% +/- 12% stenosis). Ejection fraction had risen from 50.0% +/- 15% to 54.0% +/- 14% (p less than 0.05). At follow-up (9.1 +/- 4.6 months), one patient died of noncardiac causes, and five redeveloped angina and underwent repeat procedures. Patients with fluctuating symptoms and/or ST segments are likely to have residual flow to the infarct zone, and late angioplasty may improve ventricular function in this group.
Angina Pectoris↗
Clostridium botulinum and sudden infant death syndrome: a 10 year prospective study.
It has been proposed that sudden and unexpected death in infants due to intestinal infection with Clostridium botulinum may mimic the clinicopathological features of sudden infant death syndrome. Between 3.3 and 3.8% of infants in some series have had this neurotoxin-producing bacterium isolated on faecal culture. Prospective screening of 248 infants presenting with the sudden infant death syndrome to the Adelaide Children's Hospital over a 10 year period from 1981 to 1990 was conducted. Faecal samples were obtained from both small and large intestines and cultured specifically for C. botulinum. No samples were positive. The results of this study suggest that routine post-mortem culture of faeces for C. botulinum has been of limited use within the South Australian infant population over the last decade, and that occult botulism has not been a significant factor in the causation of sudden death.
Botulism↗